Qureshi Adnan I, Janjua Nazli, Kirmani Jawad F, Harris-Lane Pansy, Suri M Fareed K, Zhou Jingying, Divani Afshin A
Clinical Trials Division, Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
J Neuroimaging. 2007 Apr;17(2):124-30. doi: 10.1111/j.1552-6569.2007.00099.x.
We prospectively evaluated the safety of aggressive mechanical disruption of thrombus following full-dose intravenous (IV) recombinant tissue plasminogen activator (rt-PA) to treat ischemic stroke in 24 patients with an initial National Institutes of Health stroke scale (NIHSS) score of >or=10.
Clinical evaluations were performed at presentation and 24 hours, 7 to 10 days, and 1 to 3 months (using modified Rankin scale) after treatment. These end points were compared to matched historical controls treated with IV rt-PA alone.
Of the 24 patients, mechanical disruption was undertaken in 17 patients with persistent angiographic occlusion using microcatheter exploration (n= 3), angioplasty (n= 5), snare maneuvers (n= 7), and combination of both (n= 2). Partial or complete recanalization was observed in 10 of the 17 patients. Neurological improvement at 24 hours (>or=4 point reduction in NIHSS score) was observed in 11 of 17 patients. Comparisons with matched controls suggest potential equivalence for symptomatic ICH (0% vs 12%), asymptomatic ICH (18% vs 15%), and early neurological improvement (65% vs 53%).
The study shows that aggressive mechanical thrombus disruption in large artery occlusion in the setting of acute ischemic stroke is safe with acceptable rates of ICH and promotes angiographic recanalization.
我们前瞻性评估了在24例初始美国国立卫生研究院卒中量表（NIHSS）评分≥10分的缺血性卒中患者中，静脉注射（IV）全剂量重组组织型纤溶酶原激活剂（rt-PA）后积极进行血栓机械性破坏的安全性。
在患者就诊时以及治疗后24小时、7至10天和1至3个月（使用改良Rankin量表）进行临床评估。将这些终点与单独接受静脉rt-PA治疗的匹配历史对照进行比较。
24例患者中，17例持续性血管造影闭塞患者采用微导管探查（n = 3）、血管成形术（n = 5）、圈套操作（n = 7）以及两者联合（n = 2）进行了机械性破坏。17例患者中有10例观察到部分或完全再通。17例患者中有11例在24小时时神经功能改善（NIHSS评分降低≥4分）。与匹配对照的比较表明，有症状性脑出血（0%对12%）、无症状性脑出血（18%对15%）和早期神经功能改善（65%对53%）可能具有等效性。
该研究表明，在急性缺血性卒中情况下，对大动脉闭塞进行积极的机械性血栓破坏是安全的，脑出血发生率可接受，并可促进血管造影再通。
